Haw. Code R. tit. 16, ch. 169, app A - Reserves and Related Actuarial Items

Asset Adequacy Tested Amounts Reserves and Liabilities
Statement Item	Formula Reserves (1)	Additional Actuarial (a) Reserves (2)	Analysis Method (b)	Other Amount (3)	Total Amount (1)+(2)+(3) = (4)
Exhibit 8 A Life Insurance
B Annuities
C Supplementary Contracts Involving Life Contingencies
D Accidental Death Benefit
E Disability - Active
F Disability - Disabled
G Miscellaneous
Total (Exhibit 8 Item 1, Page 3)
Exhibit 9 A Active Life Reserve
B Claim Reserve
Total (Exhibit 9 Item 2, Page 3)
Exhibit 10 Premiums and Other Deposit Funds
Policyholder Premiums (Page 3, Line 10.1)
Guaranteed Interest Contracts (Page 3, Line 10.2)
Other Contract Deposit Funds (Page 3, Line 10.3)
Supplementary Contracts Not Involving Life Contingencies (Page 3, Line 3)
Dividend and Coupon Accumulations (Page 3, Line 5)
Total Exhibit 10
Exhibit 11 Part 1 1 Life (Page 3, Line 4.1)
2 Health (Page 3, Line 4.2)
Total Exhibit 11, Part 1
Separate Accounts (Page 3, Line 27)
TOTAL RESERVES

IMR (General Account Page ___ Line ___)
(SEPARATE ACCOUNTS, PAGE LINE)
AVR (Page ___ Line ___)	(c)
NET DEFERRED AND UNCOLLECTED PREMIUM

Notes:

(a) The additional actuarial reserves are the reserves established under paragraphs (2) or (3) of section 16-169-4(e), Hawaii Administrative Rules.

(b) The appointed actuary should indicate the method of analysis, determined in accordance with the standards for asset adequacy analysis referred to in section 16-169-4(d), Hawaii Administrative Rules, by means of symbols which should be defined in footnotes to the table.

(c) Allocated amount of Asset Valuation Reserve (AVR).

Notes

Haw. Code R. tit. 16, ch. 169, app A